Method and device for causing tooth movement

ABSTRACT

A device for increasing movement of a tooth in a jaw includes a handle, an elongate member extending from the handle, a screw tip at a distal end of the elongate member, and a sleeve. The screw tip is configured to drill into cortical bone of the jaw to increase movement of the tooth. The sleeve is configured to move along the elongate member to vary the length of exposed screw tip.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Provisional Application No.61/486,038, filed May 13, 2011, and titled “METHOD AND DEVICE FORCAUSING TOOTH MOVEMENT,” which is herein incorporated by reference inits entirety.

INCORPORATION BY REFERENCE

All publications and patent applications mentioned in this specificationare herein incorporated by reference to the same extent as if eachindividual publication or patent application was specifically andindividually indicated to be incorporated by reference.

FIELD

The present disclosure relates to dental and orthodontic devices andmethods, particularly devices and methods for increasing the movement ofteeth in the jaw.

BACKGROUND

A large percentage of today's children and adult population undergoesorthodontic treatments at some point in their lives to treatmalocclusions (i.e. crooked teeth leading to poor bite) or improveskeletal abnormalities. Because growth and development of adult teeth isgenerally stagnant, treatment of malocclusions in adults requiresreliance on the dento-alveolar element, e.g. the ability of teeth tomove when a sufficient inflammatory response is created in the jaw.

The most common method of creating movement in teeth is through the useof braces. The braces include wires and other tensioning devices, suchas rubber bands and coils or removable trays, that exert a continuousforce on the tooth to move the tooth to a desired location. The use ofbraces to cause tooth movement, however, takes on average 18-24 monthsand can take up to 3-4 years, often causing both social and physicaldiscomfort. Accordingly, it would be advantageous to have a treatmentmethod that could successfully move a tooth or teeth in a shorter periodof time.

SUMMARY OF THE DISCLOSURE

In general, in one aspect, a device for increasing movement of a toothin a jaw includes a handle, an elongate member extending from thehandle, a screw tip at a distal end of the elongate member, and asleeve. The screw tip is configured to drill into the cortical bone ofthe jaw to increase movement of the tooth. The sleeve is configured tomove along the elongate member to vary the length of exposed screw tip.

In general, in one aspect, a method of increasing movement of a tooth ina jaw includes moving a sleeve along an elongate member of a device toset a length of exposed screw tip; drilling a hole with the screw tipthrough a cortical bone of a jaw, wherein the jaw comprises at least onetooth having an orthodontic brace thereon; and stopping the drillingwhen the length of exposed screw tip has penetrated the jaw.

These and other embodiments can include one or more of the followingfeatures.

The sleeve can be configured to move along the elongate member to setthe length of the exposed screw tip at between 0 mm and 10 mm. Thesleeve can be configured to move along the elongate member in ½ mmincrements.

The handle can further include a button configured to control movementof the sleeve. The handle can include a first end attached to theelongate member and a second end, and the first end can be rotatablewith respect to the second end. The first end can be configured tocontrol rotation of the screw.

A hole can be formed in a distal, mesial, facial or lingual surface ofthe jaw. There can be a plurality of holes formed along the mesialsurface of the jaw. A hole can be formed into a gingival flap. A holecan be formed without cutting away gingival flap prior to forming thehole. The exposed screw tip can be approximately 3 mm, for example whenthe hole is drilled proximal to a central or lateral tooth or in thepalatal. The exposed screw tip can be approximately 5 mm, for examplewhen the hole is drilled proximal to a canine or a premolar. The exposedscrew tip can be approximately 7 mm, for example when the hole isdrilled proximal to a posterior molar or in the mandible. The sleeve canbe configured to act as a drill stop.

The device can further include a pressure transducer at the distal endof the sleeve. There can be a pressure indicator on the handle, and thepressure indicator can be configured to indicate the pressure measuredby the pressure transducer.

The handle can include a plunger and a torque translator, and axialmovement of the plunger can cause rotation of the screw tip.

BRIEF DESCRIPTION OF THE DRAWINGS

The novel features of the invention are set forth with particularity inthe claims that follow. A better understanding of the features andadvantages of the present invention will be obtained by reference to thefollowing detailed description that sets forth illustrative embodiments,in which the principles of the invention are utilized, and theaccompanying drawings of which:

FIG. 1A shows an embodiment of a dental device having an exposed screwtip.

FIG. 1B shows the dental device of FIG. 1A having a covered screw tip.

FIG. 2 is a cross-section of the dental device of FIG. 1A.

FIGS. 3A-3C are exploded views of the device of FIG. 1A.

FIG. 4 shows a close-up of the screw tip of the device of FIG. 1A.

FIGS. 5A-5B show an embodiment of a dental device having a pressuretransducer to determine when the screw trip has reached a particulardepth.

FIGS. 6A-6B show an embodiment of a dental device having a separablehandle and shaft.

FIG. 7 shows an embodiment of a dental device having a plunger andtorque translator to cause rotation of the screw tip.

FIGS. 8A-8I show an embodiment of a dental device having a ratchet knobto set the screw tip and predetermined lengths.

FIGS. 9A-9E shows an embodiment of a dental device having a screw tipwith holes therein for fluid delivery.

FIG. 10A shows a microperforation dental device having a mechanicallypowered distal tip. FIG. 10B shows a microperforation dental devicehaving a laser on the distal end. FIG. 10C shows a microperforationdental device having a radiofrequency source on the distal end. FIG. 10Dshows a microperforation dental device having a water jet on the distalend.

FIGS. 11A and 11B show use of a dental device to createmicroperforations.

FIG. 12 is a chart summarizing results obtained during studies of theuse of the dental device described herein.

DETAILED DESCRIPTION

Referring to FIGS. 1-4, a device 100 is a hand-held instrument to createmicro-osteoperforation in bone and soft tissue, i.e. the device 100 canbe used to increase the movement of a tooth in a jaw. The device 100includes a handle 101 and an elongate shaft 103 extending from thehandle 101. A screw tip 105, for example made of stainless steel, can belocated at the distal end of the elongate shaft 103. A sleeve 107 can beconfigured to move along the elongate shaft 103 to vary the length ofexposed screw tip 105 (the screw tip 105 is shown exposed in FIG. 1A andfully covered in FIG. 1B).

The sleeve 107 can be released by a release mechanism, such as a button109 on the handle 101. When compressed, the button 109 can allow thesleeve 107 to move along the shaft 103, and when released, the button109 can lock the sleeve 107 in place. The button 109 can thus allow thescrew tip 105 to be set at a desired length, for example at a length ofbetween 0 mm and 10 mm. Further, in some embodiments, the device 100 canbe configured to lock the length at specific increments, for example ½mm increments. The sleeve 107, by covering all of the screw tip exceptthe exposed portion, can act as a perforation tip depth stop to preventthe screw tip 105 from penetrating the bone beyond the targeted depth.

The shaft 103 and screw tip 105 can be rotatable with respect to thehandle 101 or a portion of the handle 101. For example, the handle 101can include a first end 111 attachable to the shaft 103 and a second end113 configured to be held stationary by the user. The first end 111 canbe rotatable with respect to the second end 113 so as to controlrotation of the shaft 103, and hence rotation of the screw tip 105.

Referring to FIGS. 5A and 5B, in some embodiments, the dental device 100can further include a pressure transducer 119 on the distal end of thesleeve 107 to determine when the screw tip 105 has fully penetrated thejaw or reached the predetermined depth. An indicator mechanism, such asan indicator light 121 on the handle 101, can be used to indicate thatthe screw tip 105 has penetrated the jaw fully. For example, theindicator light 121 can change colors from a dark color (see FIG. 5A),such as green, to a light color (see FIG. 5B), such as yellow, toindicate that the pressure transducer 112 has reached the patient's gumsor when the pressure transducer 119 has measured a preset pressure.

In some embodiments, referring to FIGS. 6A-6B, a dental device 600 caninclude a shaft 603 that is separable from the handle 601. The shaft 603can include a screw tip 605 attached thereto. In some embodiments, thescrew tip 605 can be always exposed, i.e., not be coverable by a sleeveand/or have variable length settings. The screw tip can have a lengthbetween 0 and 6 mm. Similar to the dental device 100, the shaft 603 andscrew tip 605 can be rotatable with respect to the handle 601 or aportion of the handle 601. For example, the handle 601 can include afirst end 611 attachable to the shaft 603 and a second end 613configured to be held stationary by the user. The first end 611 can berotatable with respect to the second end 613 so as to control rotationof the shaft 603, and hence rotation of the screw tip 605. The shaft 603can include an attachment portion 661 that is configured to snap orscrew into the handle 601. For example, as shown in FIGS. 6A and 6B, theattachment portion can include teeth configured to interlock with teethinside the handle 601. Further, the shaft 603 can snap in and out of thehandle 601 through a release mechanism, such as a button 619. In someembodiments, a spring can be included proximal to the release mechanismto urge the shaft 603 out of the handle 601 when the release mechanismis activated. Advantageously, by having the shaft 603 be removable fromthe handle 601, the handle 601 can be used with different shafts 603,thereby allowing the shafts 603 to be disposable and the handle 601 tobe reusable.

Referring to FIG. 7, a dental device 200 can include many of the sameelements as the dental device 100, such as the screw tip 205, sleeve207, and handle 201. The handle 201 can include a plunger 231 and atorque translator 233 such that axial movement of the plunger 231 causesrotation of the screw tip 205. Further, the handle 201 can include wings235 a, 235 b to allow for better gripping of the handle. Similar to theembodiment of FIG. 5, the dental device 200 can include a pressuretransducer 219 to determine when the screw tip 205 has reached thepatient's gums. In contrast to the single indicator of FIG. 5, thedevice 200 can include multiple indicators. For example, there can betwo indicator lights 221 a, 221 b to indicate when the pressuretransducer 219 has reached the gums, i.e. has sensed a preset pressure.For example, indicator light 221 a can be a green light that indicatesthat the screw tip 205 can be advanced further, while indicator light221 b can be a red light indicating that the screw tip 205 should not beadvanced further.

Referring to FIGS. 8A-8E, a dental device 800 can include a handle 801and a shaft 803 having a screw tip 805 attached thereto. Similar toother embodiments described herein, the shaft 803 and screw tip 805 canbe rotatable with respect to the handle 801 or a portion of the handle801. For example, the handle 801 can include a first end 811 attachableto the shaft 803, such as via pins 875 (see FIG. 8D). Further, thesecond end 813 configured to be held stationary by the user. The firstend 811 can be rotatable with respect to the second end 813 so as tocontrol rotation of the shaft 803, and hence rotation of the screw tip805. In the embodiment of FIGS. 8A-8E, almost the entire device can berotatable except for a small second end 813. As a result, the second end813 can be used to place distally-directed pressure on the device 800 tohelp puncture the tissue while the rest of the device can rotate toassist in screwing the screw tip 805 into the tissue.

A sleeve 807 can be configured to move within the handle 801 and axiallyalong the shaft 803 to vary the length of the exposed screw tip 805 (thescrew tip 805 is shown exposed in FIG. 8B and fully covered in FIG. 8A).A ratcheting mechanism 881 can be used to set the sleeve 807 at thedesired length. For example, the ratcheting mechanism 881 (see FIGS.8C-8E) can be set such that the screw tip 805 is exposed at 2 mmincrements, such as at 0 mm, 3 mm, 5 mm, and 7 mm. The ratchetingmechanism 881 can include a rotatable ratchet nob 883 that can be usedto set the sleeve 807 such that the screw tip 805 is exposed at thedesired length. The ratchet nob 883 can be attached to a plurality ofratchet stops 885 having different axial lengths. The ratchet nob 883and ratchet stops 885 can be rotatable within the handle 801 withrespect to a locking portion 887. The locking portion 887 can include alock stop 889 configured to engage with one of the ratchet stops 885 toset the exposed length of the screw tip 805. Further, a spring 891 canbias the shaft 803 and screw tip 805 distally. Thus, as shown in FIG.8D, the sleeve 807 will continue to cover the screw tip 805 until aproximal force is placed on the sleeve 807, such as by tissue. Referringto FIG. 8E, once the proximally directed force is placed on the sleeve807, the sleeve 807 will move proximally against the spring 891 untilthe lock stop 889 engages with the set ratchet stop 885. If a differentlength of exposed screw tip 805 is desired, the ratchet nob 883 can berotated, thereby rotating the ratchet stops 885 such that the lock stop889 is forced to engage with a ratchet stop 885 that is of a differentaxial length.

The position of the ratchet stops 885 relative to the lock stop 889 foran exemplary device with four settings of 0 mm, 3 mm, 5 mm, and 7 mm,are shown in FIGS. 8F-8I. For example, in FIG. 8F, the lock stop 889 isin contact with a ratchet stop 885 a at the 7 mm position, therebyexposing 7 mm of the screw tip 805. In FIG. 8G, the lock stop 889 is incontact with a ratchet stop 885 b at the 5 mm position, thereby exposing5 mm of the screw tip 805. In FIG. 8H, the lock stop 889 is in contactwith a ratchet stop 885 c at a 3 mm position, thereby exposing 3 mm ofthe screw tip 805. Finally, in FIG. 8I, the lock stop 889 is in contactwith a ratchet stop 885 d at a 0 mm position, thereby keeping the screwtip 805 fully exposed.

Referring to FIGS. 8A-8E, the distal end 880 of the sleeve 807 can beconfigured to sit against the outer portion of the gums after the screwtip 805 has fully penetrated the gums. Further, a pressure transducer,such as an LED indicator 888, can be used in the device 800 to indicatewhen the screw tip 805 has reached the desired depth in the tissue. TheLED indicator 888 can work, for example, by including a battery 893 witha flexible negative lead 895 in contact with the battery 893 and apositive lead 897 spaced away from the battery 893, such as with acompression spring 899. Both leads 895, 897 can be connected to an LEDlight 898. As the sleeve 807 makes contact with the ratchet stops 885,the positive lead 897 can be pushed against the battery 893. Whencontact is made, the LED light 898 can turn on, which can shine lightthrough the LED indicator 888, indicating that the desired screw length,and thus the desired microperforation depth, has been achieved.

Referring to FIGS. 8A-8C, the handle 801 can be made of two or morepieces of material connected together. In order to prevent torque, i.e.,torque caused during rotation of the screw tip 805 to causemicroperforation, at least some of the joints can include undulations896 at the seams.

Referring to FIGS. 9A-9E, in one embodiment, a dental device 700 caninclude a handle 701 and a shaft 703 having a screw tip 705 attachedthereto. The device 700 can include any of the features of the devicesdescribed above, e.g., can include a rotatable portion and a stationaryportion, a sleeve configured to expose the screw tip, etc. The device700 can be configured to deliver a fluid, such as anesthesia, near orinto the tissue during use. A fluid cartridge 770 can be located insidethe handle 701 and be configured to hold delivery fluid therein.Further, the screw tip 705 can include holes 771 (see FIG. 9E) extendingtherethrough, for example, the screw tip 705 can be porous, to allow thefluid to pass therethrough. In one embodiment, the screw tip 705 can beformed of stainless steel, for example 17-4 stainless steel, and can beannealed and heat treated to form the holes 771. The holes 771 can beconfigured to allow a fluid, such as anesthesia, to pass through thescrew tip 705. A hypodermic needle 773 can be connected to the shaft703, which can puncture the fluid cartridge 770 when pressure is appliedthereto by a plunger 775. Accordingly, fluid from the cartridge 770 cantravel through the fluid path in the shaft 703 and screw tip 705 and outthrough the holes 771 to be delivered to the patient.

The plunger 775 of the device 700 can be a threaded plunger thatshuttles axially, such as by rotating a knob. As shown in FIGS. 9A and9B, when moved distally, the plunger 775 can be configured to push thecartridge 770 toward the hypodermic needle 773 to puncture the cartridge770. As shown in FIGS. 9A and 9B, after the hypodermic needle 773 haspunctured the cartridge 770, the plunger 775 can be configured todispense fluid as the plunger is moved further distally. A compressionspring 777 can prevent the cartridge 770 from being accidentallypunctured by the hypodermic needle 773 when the plunger is in theretracted position. The screw tip 705 and/or fluid delivery aspects ofthe dental device 700 can be used with any of the devices 100, 200, 300described herein.

In some embodiments, the devices described herein can be single usedevices. Further, in some embodiments, the devices described herein canbe operated using manual power. In other embodiments, the devicesdescribed herein can be operated electric power. Further, in someembodiments, different energy sources can be used in place of the screwtip. For example, the device can be powered with a power source (seeFIG. 10A), such as to rotate a distal screw or apply vibratory forces,can include a laser in the distal end (see FIG. 10B), can include aradiofrequency source on the distal end (see FIG. 10C), or a water jeton the distal end (see FIG. 10D). One or more of these energy sourcescan be used in place of or in addition to the screw tip of the devicesdescribed herein.

In use, any of the devices 100, 200, 300, 600, 800, 900 described hereincan be used to enhance the movement of a tooth or teeth in a jaw. Forexample, referring to FIGS. 11A and 11B, the device 100 can be used toform perforations or holes 1111 in the jaw 1113 of a patient, called“osteoperforation.” To do so, the button 109 can be depressed whilepulling the sleeve 107 toward the handle 101 to extend the screw tip105. The sleeve 107 can be adjusted to obtain the desired length ofscrew tip 105. The button 109 can then be released, locking the screwtip 105 at the desired length. The device 100 can be held atapproximately a 90 degree angle to the patient's gingival while keepingthe tissue taunt. The screw tip 105 can be rotated against the gums byrotating the handle 101, for example in a clockwise direction. Pressurecan be applied to the device 100, which, in combination with therotation of the screw tip 105, can cause a cutting edge of the screw tipto form one or more holes, such as between 1 and 10 holes, for exampleapproximately 3 holes, in the gingival flap of the jaw 113, for examplethrough a mesial surface of the jaw and/or through cortical bone of thejaw. Each hole in the jaw can be formed without cutting away a gingivalflap prior to formation of the hole. Further, each hole can be formed inthe cortical bone near a malocclusion sought to be treated. The pressureand rotation can be stopped when the desired depth has been reached,i.e. when the screw tip 105 has been advanced all the way into the jawand further penetration has been stopped by the sleeve 107. Holes ofbetween 0 mm and 10 mm deep can be formed, such as holes ofapproximately 3 mm, 5 mm, or 7 mm. The handle 101 can be rotated in theopposite direction, for example counter-clockwise, to remove the devicefrom the jaw. In is to be understood that the other devices describedherein can work in a similar fashion.

Referring to FIG. 11B, in some embodiments, the devices describedherein, such as device 100, can be used in conjunction with braces 999or other orthodontic devices.

The holes 1111 formed in the jaw 1113 can create an inflammatoryresponse within the jaw. As a result, osteoclast precursors andcytokines can be drawn to the site of the holes 1111. The cytokines canpromote osteoclast formation and activation, causing increased boneremodeling and movement. The holes 1111 formed in the jaw 1113 can thusallow a tooth or teeth to move over time to partially or fully treat themalocclusion.

The devices described herein can be used to correct major molaruprighting, major lower molar protraction, major canine protraction, andmajor intrusion. Referring to FIG. 12, the devices described herein canbe used to treat a variety of conditions, such as reducing large gapsbetween teeth caused by extractions, increasing the gap between teeth tomake space for implants, reducing overjet and overbite, and reducingovercrowding (see column B). The time required for treatment of suchconditions using the devices described herein (see column E) can besignificantly reduced relative to the established traditional time fortreatment with braces (see column D). When ostoperforation is used withthe devices described herein, the treatment time for such malocclusionscan be decreased by over 30%, such as over 40%, for example by more than50%, relative to the use of braces. For example, the time for treatmentcan be reduced from 8 months to 4 months, 2 months to 4 weeks, 6 monthsto 3 months, 12 months to 5 months, 24 months to 11 months, 24 months to13 months (see columns D and E).

Advantageously, all of the devices described herein can be configured tohave an adjustable-length screw tip. The adjustable length allows thedevices to be controlled more precisely during the formation of holesand therefore allows the devices to be accurately and safely used inbone of different thicknesses and/or densities. Accurate and safe use ofthe device in bone of different thicknesses and/or densities allows thedevice to be used in different patients and in different types of teeth.For example, the maxilla is thinner than the mandible and thereforerequires the formation of holes of a smaller depth than holes formed inthe mandible. Likewise, the depth of penetration required to perforatethrough cortical bone into cancellous bone increases when moving fromthe maxilla or mandible posteriorly. As another example, an athleticmale patient will typically have thicker and/or denser teeth than ayoung female or an elderly woman. Accurately and safely setting thescrew tip length, and thus the depth of penetration, can allow thedevice to be used in any of these scenarios. Further, the same devicecould advantageously be used to drill holes of different depths near twodifferent teeth of the same patient.

In one aspect, the screw tip can be set to approximately 3 mm whenforming holes proximal to a central or lateral tooth or in the palatal.In another aspect, the screw tip can be set to approximately 5 mm whenforming holes proximal to a canine, a premolar, or a molar in a femaleor a small male. In another aspect, the screw tip can be set toapproximately 7 mm when forming holes proximal to posterior molars, inthe mandibular, or in the maxillary in large men.

Use of the device described herein for osteoperforation advantageouslytaps a bone metabolism process that safely accelerates motion. Themicroperforation process using the devices described herein is safe,simple, and produces local alveolar bone reactions that enable rapidmotion of teeth. Further, the process can be performed in-office and, asdescribed above, can be performed precisely for a broad range ofpatients and in a broad range of different types of teeth.

What is claimed is:
 1. A device for forming holes in the cortical boneadjacent a tooth in order to increase movement of the tooth, the devicecomprising: a handle; an elongate member extending from the handle; ascrew tip at a distal end of the elongate member, wherein the screw tipis configured to drill into cortical bone to increase movement of thetooth; a spring biased sleeve, the sleeve configured to rest againsttissue during use and allow movement of the elongate member with respectto the sleeve to vary the length of exposed screw tip as force isapplied to the handle; and an adjustable lock stop configured to stopthe movement of the elongate member relative to the sleeve when thelength of exposed screw tip corresponds to a preselected limit.
 2. Thedevice of claim 1, wherein the preselected limit is between 0 mm and 10mm so as to prevent the device from penetrating the cortical bone morethan the preselected limit.
 3. The device of claim 1, wherein thepreselected limit can be set at set at 0.5 mm increments.
 4. The deviceof claim 1, wherein the handle comprises a first end attached to theelongate member and a second end, the first end rotatable with respectto the second end.
 5. The device of claim 4, wherein the first end isconfigured to control rotation of the screw tip.
 6. The device of claim1, wherein the sleeve is configured to act as a drill stop for the screwtip.
 7. The device of claim 1, further comprising a pressure transducerat a distal end of the sleeve.
 8. The device of claim 7, furthercomprising a pressure indicator on the handle, the pressure indicatorconfigured to indicate the pressure measured by the pressure transducer.9. The device of claim 1, wherein the handle comprises a plunger and atorque translator, and wherein axial movement of the plunger causesrotation of the screw tip.